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HealthCert Education > Difficult benign lesions > Flashcards

Difficult benign lesions Flashcards

1
Q

Dermoscopy accuracy in melanoma detected: NNE

A

Using Dermoscopy 8.7

Not using Dermoscopy 29.4

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2
Q

4 main simulators of melanoma

A
  1. Melanoma-like nevi
  2. Melanoma-like seb keratosis
  3. Spitzoid looking lesions.
  4. Nevi with special features.
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3
Q

Strategies to reduce biopsies

A
  1. Tape stripped of dark nevus.

2. Take into account patient related factors.

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4
Q

Skin type vs typical pigmented melanocytic nevi.

A

Fitz type
I: Light brown, central hypopigmentation
II: Light brown, multifocal hyper or hypopigmentation.
III: As above
IV: Dark brown. Central hyperpigmentation.

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5
Q

Dermoscopic island definition

A

Dermoscopic area that differs from the remaining lesion.

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6
Q

Dermoscopic island - common patterns

A

Reticular
Globular
Homogenous
Starburst

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7
Q

What % of MIS, melanoma, and atypical nevi contain a dermoscopic island.

A

MIS: 10.4
Melanoma: 4.1%
Atypical nevi: 3.1 %

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8
Q

Dermoscopic island: Odds ratio for melanoma.

A

1.9

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9
Q

Dermoscopic island: Specificity for melanoma.

A

96.9%

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10
Q

Dermoscopic island - invasive melanoma with this features is …

A

thinner

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11
Q

What % of melanoma with dermoscopic island arise in nevus?

A

50%

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12
Q

What can you use to distinguish between nevus and melanoma in presence of dermoscopic island?

A

Conflocal microscopy

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13
Q

Lesions with regression - blue white structures. Rule for excision.

A

BW lesions > 50% of lesion - excise

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14
Q

Sclerosing nevus with psuedomelanomatous features: clinical presentation

A

Young adults, middle aged

Typical located on Convex area of Back.

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15
Q

Sclerosing nevus with psuedomelanomatous features: Dermoscopy

A

Polychromatic with both white and blue regression like fibrosis.

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16
Q

Melanoma-like seborrheic keratosis: What % of excised tumour are SK?

A

3.8%

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17
Q

Melano-acanthoma

A

Striking pigmentation in tne centre.

Typical features of seborrheic keratosis at the border

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18
Q

Features of SK: Dermoscopy

A 
Sharply demarcated border. jelly like
Brown color
Fat finger
Cerebriform pattern
Comedo like openings
Vessels with white surround
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19
Q

Clonal seborrheic keratosis, histopath

A

Sharply demarcated intra-epithelial nests of basaloid or pale cells.
In some cases nests composed of larger cells with conspicuous intercellular bridges and are separated by strands of cells with small dark nuclei.

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20
Q

Clonal seborrheic keratosis, distribution and epidemiology

A

head and neck
followed by trunk and extremities
first 3 decades of life

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21
Q

Clonal seborrheic keratosis, clinical

A

flat to slightly palpable pigmented lesions ranging in colour from light brown to dark brown and revealing sharply demarcated borders.

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22
Q

Clonal seborrheic keratosis, Dermoscopy

A

large globular like structures and bluish globular like structures with a more pronounced pigmentation in the centre resembling the so called “concentric” structures of BCC

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23
Q

Clonal seborrheic keratosis, role of confocal microscopy

A

Can help to identify the nests

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24
Q

Spitzoid looking lesions - major groups

A

Children < 12

Adults

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25
Q

Spitzoid, pattern in children < 12

A

Amelanotic pattern with dotted vessels
Starburst
Globular

26
Q

Spitzoid nevus in children, management

A

Flat - follow up

Nodular - excise

27
Q

Desmoplastic spitz nevus clinical

A

Reddish appearance of nodules or plaque

28
Q

Angiomatous spitz nevus clinical

A

Reddish colour

29
Q

Verracous spitz nevus clinical

A

Raised lesion, verrucous

30
Q

Likelihood of finding melanoma in symmetric spitzoid looking tumour by age

A

>

  1. 13.3%

>50. 50%

31
Q

Management decision for Spitz Nevi > 11 years old

A

Excise

32
Q

Does confocal microscopy play role in differentiation spitz nevi from melanoma

A

Only in flat lesions with starburst and globular pattern.

33
Q

Nevi with special features

A 
Balloon cell nevus
Targetoid hemosiderotic nevus
Meyerson nevus
Sutton or Halo nevus
Recurrent nevus
Combined nevi
34
Q

Balloon cell nevus: Histopath

A

Predominance or complete occurrence of large vesicular clear cells, called balloon cells.

35
Q

Balloon cell nevus: Distribution

A

Head and neck followed by trunk and extremities

36
Q

Balloon cell nevus Clinical

A

Generally brown,
may appear as smooth papule,
may be polypoid

37
Q

Balloon cell nevus Dermoscopy

A

Numerous aggregated white/yellow globular structures that correspond to balloon cell nevi nests.

38
Q

Ballon cells, definition

A

Melanocytes with pale-staining and vacuolated cytoplasm which often has a defect in melanosome formation

39
Q

Targetoid hemosiderotic nevus: Definition

A

Characterized by violaceous eccymotic halo

40
Q

Targetoid hemosiderotic nevus: Also known as ..

A

Traumatized nevus

41
Q

Targetoid hemosiderotic nevus: Pathogenis

A

Hemorrhage dt trauma

42
Q

Targetoid hemosiderotic nevus: Clinical

A

Nodular pre-existing nevus with sudden color change and violaceous hue.

43
Q

Targetoid hemosiderotic nevus: Dermoscopy

A

Mostly globular or structureless brown pattern superimposed by structureless red to purple to black areas and violaceous hue.

44
Q

Targetoid hemosiderotic nevus represent exception to rule …..

A

to not follow ip doubtful palpable lesions

very short term monitoring - 2 weeks.

45
Q

Meyerson nevus: Definition

A

development of eczematous halo around one or more pigmented nevi

46
Q

Meyerson nevus: Epidemiology

A

Any age, more frequent young health adults

47
Q

Meyerson nevus: Clinical

A

Erythematous halos with overlying scales sometimes accentuated at periphery of erythematous zones.

48
Q

Meyerson nevus: Dermoscopy

A

Yellowish overlying superficial serocrust

49
Q

Meyerson nevus: Confocal microscopy features

A

Spongiotic vessels

50
Q

Sutton or Halo nevus: definition

A

surrounded by achromic rim that simulates a halo.

51
Q

Sutton or Halo nevus: epidemiology

A

Usually appear in children or young adults.

Average age onset 15 years.

52
Q

Sutton or Halo nevus: Association

A

Associated with atopic dermatitis or autoimmune disorders such as vitiligo or Hashimoto thyroiditis

53
Q

Sutton or Halo nevus: Dermoscopy

A

Central globular or homogenous pattern surrounded by variable rim of a white regression-like depigmentation.

54
Q

Sutton or Halo nevus: Outcome

A

Nevus tends to disappear

55
Q

Recurrent nevus: Definition

A

Benign melanocytic nevus that regrow following incomplete surgical excision or trauma.

56
Q

Recurrent nevus: Clinical

A

Macular area of scar with variegated hyperpigmentation, and hypo pigmentation, linear streaking and halo, stippled, and or diffuse pigmentation

57
Q

Recurrent nevus: Dermoscopy

A

Benign recurrences are confined to the scar, arising in the centre of the scar and extending within the scar.

58
Q

Recurrent nevus: Parameters to evaluate

A
  1. Time: Rapid development likely benign. Months to years may be melanoma.
  2. Pigment distribution. Within scar, centrifugal or in lines perpendicular likely benign. From edge of scar invading surrounding skin likely malignant.
  3. Dermoscopy. Confined within scar - benign.
59
Q

Recurrent melanoma, as opposed to recurrent nevi, are more frequently found on ….

A

Head and neck.

60
Q

Combined nevi: Definition

A

histopathological presence of two different types of melanocytic proliferations within the same nevus

61
Q

Combined nevi: Most frequent combination.

A

Blue nevus with Spitz, acquired or congenital melanocytic nevus

62
Q

Combined nevi: Dermoscopy

A

Colour variegation or more than one structure.

HealthCert Education (24 decks)

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